Hello Dr. Hall,
I had a recent dental cleaning and there were several protocols in place to screen for COVID. One of the things that surprised me was that the hygienist requested that I rinse with peroxide before she cleaned my teeth. I asked if it was related to COVID, and she said yes. She actually said she has been requesting this of patients for over 15 years, even during ‘normal’ times. How effective is this in preventing the spread of viruses? Are all dentists doing this?
Jamie from Colorado
(See Dr. Hall’s answer below.)
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The concern is over aerosols that are generated during a dental appointment. Especially if your hygienist uses an ultrasonic scaler, aerosols are generated that escape into the air of the dental office and can circulate throughout the office. They can remain suspended in the air for several hours. Everyone in the office can then inhale them.
There are several ways of reducing infectious aerosols produced by dental treatment. One way is the use of high-volume suction equipment. When the dentist does procedures, usually the dental assistant will be tasked with holding the high-volume suction close to the field of operation. While that doesn’t provide perfect protection against infectious aerosols, it has been shown to reduce them by about 95%. This method, however, is usually not practical for dental hygiene appointments because there is normally not a dental assistant present.
Recent advertisements to dentists have promoted suction devices with wide openings of a foot or more in width that can be placed near the operatory field. Here is a screen shot of an advertising that I recently received for one of these devices.
This device will capture aerosols into a box with a filter. While a nice idea, my worry would be that the clear shield could get in the way. I noticed the photograph doesn’t have a dental assistant present, and while the dentist, using quality magnification, could maybe work around the shield, I have difficulty picturing how the assistant would.
Another effective option is, rather than reducing the aerosols, to make them less infectious. This is where the pre-operative rinse comes in. In recent years, dental hygiene schools have been teaching hygienists to use a pre-operative rinse before each appointment, but only a small minority of hygienists have actually been doing that. However, with COVID-19, I believe the use of those rinses may be near 100%. In some states, they have actually become mandatory.
There are several anti-microbial rinses that are used. I believe that the peroxide rinse is the most effective because of its quick action to kill oral micro-organisms. The peroxide used is a little more concentrated than you would buy over the counter. What is sold to the public is a 3% peroxide. For dental appointments, while the American Dental Association recommends at least a 1.5% concentration, a number of offices are using rinses with about 4 or 5%. A swish for a few seconds is fairly effective at killing bacteria and viruses. The aerosols then that are generated during your cleaning or other dental treatment will then be much less infectious.
– Dr. Hall
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